The recent Supreme Court ruling in the case about mifepristone, a medication abortion drug, offered a temporary reprieve in a judicial climate that has been increasingly hostile to abortion access. The court ruled that the antiabortion doctors behind the case had no standing to sue. But the decision isn’t a complete win; the case could come back, and in the meantime state bans and limited access to telehealth will still keep many people from being able to quickly use this medication. The decision comes amid an onslaught of ideologically motivated lawsuits and regulations trying to limit reproductive health care, including access to contraception or birth control.
In this increasingly restrictive context, people are turning to the freewheeling landscape of Instagram and TikTok seeking birth control information.They are met by a slew of posts of people sharing their personal experiences and warning viewers about side effects or symptoms they have experienced while on birth control. Some record having intrauterine devices (IUDs) inserted, sharing their experiences of discomfort and pain in real time. Other videos are scientifically inaccurate or unsound, including ones that talk about birth control causing hormone imbalance or copper toxicity. These posts often promote birth control methods that do not use medications or devices, or are aimed at selling a holistic idea or product.
As family medicine physicians and researchers, we want people to have all the information they need to make the birth control choices that are right for them, including fertility awareness methods. But we are alarmed by the sheer volume of online content that misinforms people, whether honestly or intentionally. Particularly alarming are videos designed to sway opinions for financial or ideological gain; they are a form of contraception coercion, an attempt to control or influence a person’s decision about whether to use birth control or what type of birth control to use.
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Many videos with honest intent fail to provide context and imply individual birth control experiences are universal. While any one person’s experience with birth control is valid and legitimate, ultimately each person’s experience with birth control is unique. In making an important medical decision based on a few peoples’ experiences posted on the Internet, people in need of birth control could be walking away from safe and well-tested options that would make a difference in their reproductive lives. Even worse, right-wing influencers are exploiting legitimate medical mistrust to discredit birth control and reinstate patriarchal gender norms, by posting disinformation masquerading as wellness content.
While the medium is new, the problem of contraceptive coercion is not. Health care providers themselves have long engaged in contraceptive coercion through forced sterilization and by pushing certain methods—most often highly effective, long-acting contraception such as IUDs and implants—regardless of patients’ needs or desires. This kind of coercive contraceptive counseling has been particularly likely to be directed at Black, Indigenous and other people of color, who are more likely to have IUDs recommended and to receive disrespectful care resulting from implicit bias and systemic racism in the health care system.
Clinicians have also prioritized preventing pregnancy over people’s own preferences and experiences with methods following a false notion that birth control efficacy overrides all other factors when choosing a birth control method; as a result, they have discounted symptoms and side effects that people have experienced with hormonal contraception and have minimized the discomfort and pain that can be associated with placement of long-acting contraceptives like IUDs, which in turn has led to some of these videos of people attempting to fill in the gaps left by their own providers.
Such a history of coercion fuels distrust in the context of reproductive health care. Providers must recognize that effectiveness may not be the highest priority for people using contraception when weighed against other things like changes to their periods, being able to stop a method without provider assistance, and side effects. This type of coercive counseling that is not focused on people’s own needs or preferences reinforces mistrust of contraceptive providers.
If we in the health care system want to rebuild the trust we have lost with these coercive practices, we must work to center people’s expertise in their own values, health, lives and experiences. Using this values-based approach to contraceptive counseling and care, we can prioritize what matters most to people beyond efficacy, such as believing patients about experiences with side effects and working proactively to address them.
Pushing back against the flood of harmful content requires establishing trusted sources of information and counteracting widespread misinformation and disinformation with supportive, positive, resources that are free of judgment. Experts can use these same platforms to highlight accurate information about birth control. We can point people toward reliable, accurate resources like the Reproductive Health Access Project’s contraceptive options chart or zine and Bedsider’s interactive website.
We need to rebuild trust. With more attacks on contraception and contraceptive access likely on the way, we must urgently, proactively respond so young people will be less exposed and susceptible to propaganda aimed at peeling back reproductive autonomy. People deserve a full range of honest, accurate information to truly make an informed decision about the contraceptive approach that works best for their body and lives.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.